Provider Demographics
NPI:1366743023
Name:TINNIN, ERNEST PAUL JR
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:PAUL
Last Name:TINNIN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3440 E RUSSELL RD # 211
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-2201
Mailing Address - Country:US
Mailing Address - Phone:702-960-5484
Mailing Address - Fax:702-214-4289
Practice Address - Street 1:3440 E RUSSELL RD # 211
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-2201
Practice Address - Country:US
Practice Address - Phone:702-646-5437
Practice Address - Fax:702-396-4193
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner